Policy processes in multisectoral tobacco control in India: the role of institutional architecture, political engagement and legal interventions

Shinjini Mondal, Sara Van Belle, Upendra Bhojani, Susan Law, Antonia Maioni

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Background: The development and implementation of health policy have become more overt in the era of Sustainable Development Goals, with expectations for greater inclusivity and comprehensiveness in addressing health holistically. Such challenges are more marked in low- and middle-income countries (LMICs), where policy contexts, actor interests and participation mechanisms are not always well-researched. In this analysis of a multisectoral policy, the Tobacco Control Program in India, our objective was to understand the processes involved in policy formulation and adoption, describing context, enablers, and key drivers, as well as highlight the challenges of policy. Methods: We used a qualitative case study methodology, drawing on the health policy triangle, and a deliberative policy analysis approach. We conducted document review and in-depth interviews with diverse stakeholders (n = 17) and anlayzed the data thematically. Results: The policy context was framed by national law in India, the signing of a global treaty, and the adoption of a dedicated national program. Key actors included the national Ministry of Health and Family Welfare (MoHFW), State Health Departments, technical support organizations, research organizations, non-governmental bodies, citizenry and media, engaged in collaborative and, at times, overlapping roles. Lobbying groups, in particular the tobacco industry, were strong opponents with negative implications for policy adoption. The state-level implementation relied on creating an enabling politico-administrative framework and providing institutional structure and resources to take concrete action. Conclusion: Key drivers in this collaborative governance process were institutional mechanisms for collaboration, multi-level and effective cross-sectoral leadership, as well as political prioritization and social mobilization. A stronger legal framework, continued engagement, and action to address policy incoherence issues can lead to better uptake of multisectoral policies. As the impetus for multisectoral policy grows, research needs to map, understand stakeholders' incentives and interests to engage with policy, and inform systems design for joint action. Keywords: Policy Analysis, Multisectoral, Tobacco, Governance, India Copyright: (c) 2021 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation:Mondal S, Van Belle S, Bhojani U, Law S, Maioni A. Policy processes in multisectoral tobacco control in India: the role of institutional architecture, political engagement and legal interventions.Int J Health Policy Manag. 2021;x(x):x-x. doi:10.34172/ijhpm.2021.66

Original languageEnglish
JournalInternational Journal of Health Policy and Management
Issue number9
Pages (from-to)1703-1714
Number of pages12
Publication statusPublished - 2022


  • Policy Analysis
  • Multisectoral
  • Tobacco
  • Governance
  • India

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